Professional Documents
Culture Documents
Lexington, Kentucky
2013
APRIL 8-11
www.keenelandconference.org
121 Washington Avenue Suite 212 Lexington, Kentucky 40536 Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org
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121 Washington Avenue Suite 212 Lexington, Kentucky 40536 Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org
General Info
April 8, 2013 On behalf of the National Coordinating Center for Public Health Services and Systems Research, Public Health Practice-Based Research Networks National Coordinating Center and the Robert Wood Johnson Foundation, we are pleased and honored to welcome you to the 2013 PHSSR Keeneland Conference in Lexington, Ky. Like milestones in our own lives, the Keeneland Conference serves as an opportunity to reflect on the past and look toward the future. And what an exciting time to do so! The field of PHSSR is growing by leaps and bounds, which is reflected by the growth in our conference. We experienced a record number of abstract submissions for this years conference, corresponding with a record number of presentations and sessions. But more than the number, we are impressed with the quality of the science in the submissions. The level of discourse in the field reflects how far we have come. Now we are celebrating PHSSRs coming of age, as reflected in the outstanding presentations, plenaries, posters and roundtables that we have in store for you. This years program is designed to bring you the most current information in the field from a variety of different voices. We are extremely proud to be able to bring you the perspectives of our three prominent keynote speakers: Paul Kuehnert, Robert Wood Johnson Foundation; Joe Selby, Patient-Centered Outcomes Research Institute; and William Roper, UNC Health Care System. Our plenary sessions will bring you up to speed on developments in Washington (moderated by Lisa Simpson of AcademyHealth) and Quality Improvement in PHSSR, a formative evaluation from the Urban Institute. Also, for the first time this year, youll have the opportunity to learn about various research topics through an informal Breakfast Roundtable on Wednesday morning. On Thursday morning, well conclude with a lively and informative session featuring teams of researchers and practitioners who will share their real-life stories of successful collaborations proof positive that were making a difference in public health practice. After the session wraps up, consider staying with us for a visit to Lexingtons historic Keeneland Race Course for lunch and a memorable afternoon at a Kentucky gem. Again, we welcome you to the Bluegrass. Our staff is committed to making your time with us both productive and enjoyable. We look forward to this opportunity to share our collective successes and plan for tomorrow. Thank you for joining us! Sincerely,
111 Washington Avenue Suite 212 Lexington, Kentucky 40536 Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org
General Info
The 2013 Keeneland Conference on Public Health Services & Systems Research made possible with support from the Robert Wood Johnson Foundation TABLE OF CONTENTS
Welcome.................................................. 1 Sponsor & Contents............................... 2 Hotel Information.................................. 3 General Information............................... 5 Keynote Speakers.................................... 7
Paul L. Kuehnert, M.S., R.N. William L. Roper, M.D., M.P.H. Joe V. Selby, M.D., M.P.H.
The Robert Wood Johnson Foundation (RWJF) and its partners have committed significant funding to further the field of Public Health Services & Systems Research (PHSSR). Under the Foundations direction, the National Coordinating Center for PHSSR continues to build the evidence base, expand the research capacity, encourage the translation of research into practice and expand the funding sources available to the community.
Agenda Monday (04.08.13)....................... 11 Tuesday (04.09.13)........................ 11 Wednesday (04.10.13).................. 12 Thursday (04.11.13)...................... 13 Plenary Sessions and Roundtable......... 15 Concurrent Sessions Session I.......................................... 23 Session II......................................... 39 Session III....................................... 55 Session IV....................................... 71 Poster Sessions....................................... 87
General Info
GENERAL INFORMATION
Parking
Amenities
Hyatt Grand Beds iHome stereo w/ iPod docks Indoor heated pool Outdoor sun deck The shops at Lexington Center 24 hour StayFitTM gym
Airport Shuttle
Locations & Connectivity Public Areas Wireless free for hotel guests Guest Rooms Wireless is $9.99 per 24-hour period.
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Internet Access
General Info
Level 3
ADDRESS: Lexington Convention Center 430 West Vine Street Lexington, KY 40507 Tel: (8 859) 233-4567 www.lexingtoncenter.com
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General Info
Contacts
Vikki Y. Franklin 859.230.8052 Rebecca Brown 859.437.0034 Kara Richardson 859.327.2825
Meeting Venue
Lexington Convention Center 430 W. Vine St. Lexington, KY 40507 (859) 233-4567
Hotels
Hyatt Regency Lexington 401 W. High St. Lexington, KY 40507 (859) 253-1234 Hilton Lexington/Downtown 369 W. Vine St. Lexington, KY 40507 (859) 231-9000
Hyatt Transportation
For Hyatt Regency Lexington guests, courtesy car service is available to and from the Hyatt on a complimentary basis from 6 a.m. to midnight daily.A courtesy phone is available near the baggage claim area. Return times must be arranged through the Hyatts guest department at the hotel. A blue or grey van bearing the insignia of Hyatt Regency Lexington provides service to the hotel.
Thursday, April 11
7:30 a.m.-11 a.m. Thoroughbred Prefunction Entrance (Convention Center)
Exhibitors Table
Located next to the registration table in the Thoroughbred Prefunction Entrance of the Convention Center, an exhibitors table is available for conference attendees to place materials and other resources to share with other attendees.
General Info
Dress Code
No denim of any color, shorts or athletic attire. Gentlemen - coat and tie are required. Ladies - skirts, dresses, dress slacks, or capris are required. Any dressy shoes.
Meeting Evaluation
Shortly after our conference concludes, you will receive a survey asking for feedback about the 2013 Keeneland Conference. We ask that you please take a few minutes to complete the survey to provide us valuable feedback, and we thank you in advance. Link: http://bit.ly/keeneland2013
Menu
Keeneland offers famous corned beef, roast sirloin, chicken entree, vegetables du jour, potato du jour, salad bar, dessert, iced tea and coffee. Alcoholic beverages, juice and soft drinks are not included.
Arrival Time
Guests must arrive by 1:15 p.m. on the day of their reservation or their table will be resold and tickets will be invalid. Room opens at 11 a.m. The buffet is available from 11:30 - 3:00 p.m.
Social Media
Tell the rest of the world whats happening at the Keeneland Conference! Please use the hashtag #PHSSRKC13 when posting on Twitter.
Parking
More than 10,000 parking spaces are available within a 10-minute walk of the Lexington Center. All surrounding parking lots and garages offer spaces for guests with disabilities. Additional details and directions can be found on the Convention Centers website, www.visitlex.com.
Transportation
Both buses will be located at the High Street entrance of the Lexington Convention Center.
Bus A
Bus A will leave the Lexington Convention Center at 11:30 am. The first stop will be at the Bluegrass Airport. Attendees can check their bags and get their boarding passes. The bus will leave the airport and go on to Keeneland by 12:15 p.m. At 3 p.m., the bus will leave Keeneland and go back to the airport. NOTE: Bus A will NOT return to the hotel or Convention Center.
Free
The Lexington Center parking lot on Manchester Street is open on non-arena event days and is free to attendees.
Hourly
The Lexington Center parking lot on High Street is open on non-arena event days for $7.00 all day, or $1.00 for the first half-hour, and $0.75 for each half hour after. Three hours free parking are available with merchant validation in the Shops at Lexington Center (purchase necessary). On arena event days, fees vary.
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Bus B
Bus B will leave the Lexington Convention Center at 11:30 a.m. The bus will go directly to Keeneland and should arrive by noon. At 4 p.m., the bus will leave Keeneland and return to the Hyatt.
Keynote Speakers
Kuehnert
Paul L. Kuehnert, D.N.P., R.N. Senior Program Officer and Team Director, Public Health Robert Wood Johnson Foundation Paul Kuehnert is a senior program officer and the team director for the Public Health team. Coming of age in the 1960s with parents who were faith community-based activists for peace and justice, it wasnt that big of a surprise to anyone in his family when Paul decided to flout gender norms and become a nurse. What started as a bit of a dare and a way to make ends meet transformed into a vocation when he became a public health nurse early in his career. Serving children and parents in St. Louis Head Start Program ignited his passion for community-focused health promotion and advocacya passion that just wont quit. As an executive leader for the past 20 years, Paul has led both governmental and community-based organizations in order to help people lead healthier lives. In the late 1980s he was a founder and later CEO of Community Response, Inc., one of the Chicago areas largest housing, nutrition and social service providers for people living with HIV/AIDS. He moved to Maine in 1999 and served in the state health department, leading the development of a regional public health system, and becoming deputy director of the department in 2005. Most recently Paul was the county health officer and executive director for health in Kane County, Ill., a metro Chicago county of 515,000, where he initiated and led Making Kane County Fit for Kids, a public-private partnership to reverse the epidemic of childhood obesity. Paul is a pediatric nurse practitioner and holds a master of science degree in public health nursing from the University of Illinois at Chicago. He was named a Robert Wood Johnson Foundation Executive Nurse Fellow in 2004.
Keynote Speakers
Roper
William L. Roper, M.D., M.P.H. Chief Executive Officer UNC Health Care System William L. Roper is Dean of the School of Medicine, Vice Chancellor for Medical Affairs and Chief Executive Officer of the UNC Health Care System at the University of North Carolina at Chapel Hill. He also is Professor of Pediatrics in the School of Medicine and Professor of Health Policy and Administration in the School of Public Health. From 1997 until March 2004, Dr. Roper was Dean of the School of Public Health at UNC. Before joining UNC in 1997, Dr. Roper was senior vice president of Prudential HealthCare. He joined Prudential in 1993 as president of the Prudential Center for Health Care Research. Before coming to Prudential, Dr. Roper was director of the Centers for Disease Control and Prevention (CDC), served on the senior White House staff, and was administrator of the Health Care Financing Administration. Earlier, he was a White House Fellow. He received his M.D. from the University of Alabama School of Medicine, and his M.P.H. from the University of Alabama at Birmingham School of Public Health. He completed his residency in pediatrics at the University of Colorado Medical Center. Dr. Roper is a member of the Institute of Medicine of the National Academy of Sciences. He is a member of the board of directors of DaVita, Inc., a member of the board of directors of Medco Health Solutions, Inc., a member of the Scientific Management Review Board of the NIH, a member of the board of directors of the Partnership for a Healthier America, and chairman of the board of directors of the National Quality Forum.
Keynote Speakers
Selby
Joe V. Selby, M.D., M.P.H. Executive Director Patient-Centered Outcomes Research Institute (PCORI) Joe Selby is the first Executive Director of the Patient-Centered Outcomes Research Institute (PCORI). A family physician, clinical epidemiologist and health services researcher, Dr. Selby has more than 35 years of experience in patient care, research and administration. He is responsible for identifying strategic issues and opportunities for PCORI and implementing and administering programs authorized by the PCORI Board of Governors. Dr. Selby joined PCORI from Kaiser Permanente, Northern California, where he was Director of the Division of Research for 13 years and oversaw a department of more than 50 investigators and 500 research staff working on more than 250 ongoing studies. He was with Kaiser Permanente for 27 years. An accomplished researcher, Dr. Selby has authored more than 200 peer-reviewed articles and continues to conduct research, primarily in the areas of diabetes outcomes and quality improvement. His publications cover a spectrum of topics, including effectiveness studies of colorectal cancer screening strategies; treatment effectiveness, population management and disparities in diabetes mellitus; primary care delivery and quality measurement. Dr. Selby was elected to membership in the Institute of Medicine in 2009 and was a member of the Agency for Healthcare Research and Quality study section for Health Care Quality and Effectiveness from 1999-2003. A native of Fulton, Missouri, Dr. Selby received his medical degree from Northwestern University and his masters in public health from the University of California, Berkeley. He was a commissioned officer in the Public Health Service from 1976-1983 and received the Commissioned Officers Award in 1981.
Agenda
Hyatt Regency Lobby Level Regency Ballroom 2 & 3 Hyatt Regency Lower Level A Kentucky Hyatt Regency Lobby Level Regency Ballroom 1, 2 & 3 Hyatt Regency Lower Level A Kentucky Lexington Convention Center Bluegrass Ballroom 2
2 to 3:15 pm
Lexington Convention Center Thoroughbred 1 Thoroughbred 2 Thoroughbred 3 Thoroughbred 5 & 6 Thoroughbred 7 & 8 Lexington Convention Center Bluegrass Ballroom 2 Lexington Convention Center Thoroughbred Prefunction Area Lexington Convention Center Thoroughbred Prefunction Area
Dinner: Lexington Convention Center Joe V. Selby, M.D., M.P .H. Bluegrass Ballroom 2 Executive Director Patient-Centered Outcomes Research Institute (PCORI)
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Agenda
Wednesday, April 10, 2013
7:30 to 8:30 am 9 to 10:15 am Breakfast-Roundtable Session See page 16 for list of topics Concurrent Scientific Sessions See page 39 for full details 2A-Preparedness 2B-Translation I 2C-Organization 2D-Quality Improvement I 2E-Technology & Data II Concurrent Scientific Sessions See page 55 for full details 3A-Technology & Data III 3B-Workforce II 3C-Translation II 3D-Quality Improvement II 3E-Social Network Analysis Lunch: William L. Roper, M.D., M.P.H. CEO UNC Health Care System Concurrent Scientific Sessions See page 71 for full details 4A-Accreditation 4B-Workforce III 4C-Food Safety 4D-Disparities 4E-Technology & Data IV A Formative Evaluation of PHSSR See page 19 for full details Poster Session B See page 89 for full details Networking Reception Dine-A-Round Lexington
Lexington Convention Center Bluegrass Ballroom 2 Lexington Convention Center Thoroughbred 1 Thoroughbred 2 Thoroughbred 3 Thoroughbred 5 & 6 Thoroughbred 7 & 8 Lexington Convention Center Thoroughbred 1 Thoroughbred 2 Thoroughbred 3 Thoroughbred 5 & 6 Thoroughbred 7 & 8 Lexington Convention Center Bluegrass Ballroom 2
10:45 am to 12 pm
12:30 to 1:30 pm
2 to 3:15 pm
Lexington Convention Center Thoroughbred 1 Thoroughbred 2 Thoroughbred 3 Thoroughbred 5 & 6 Thoroughbred 7 & 8 Lexington Convention Center Bluegrass Ballroom 2 Lexington Convention Center Thoroughbred Prefunction Area Lexington Convention Center Thoroughbred Prefunction Area Various Local Restaurants
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Agenda
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Plenary Sessions
Tuesday, April 9, 2013 3:45 to 4:45 pm Washington Update: PHSSR and Policy Translation Bluegrass Ballroom 2
Find out the inside scoop on whats happening inside the Beltway - from sequestration to the Affordable Care Act and how it directly and indirectly affects PHSSR from those who know. AcademyHealth is the National Coordinating Center for PHSSRs partner in Washington. The moderator and panelists will share their insight regarding issues to watch on the federal level.
MODERATOR
Lisa Simpson, M.B., B.Ch., M.P.H. President and CEO AcademyHealth
PANELISTS
Paul Jarris, M.D., M.B.A. Executive Director Association of State and Territorial Health Officials (ASTHO) ASTHO is the national nonprofit organization representing public health agencies in the United States, the U.S. Territories, and the District of Columbia, and over 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, formulate and influence sound public health policy and ensure excellence in state-based public health practice. ASTHOs primary function is to track, evaluate, and advise members on the impact and formation of public or private health policy that may affect them and to provide them with guidance and technical assistance on improving the nations health. Jeff Levi, Ph.D. Executive Director Trust for Americas Health (TFAH) TFAH is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. By focusing on prevention, protection, and communities, TFAH is leading the fight to make disease prevention a national priority, from Capitol Hill to Main Street. Robert Pestronk, M.P .H. Executive Director National Association of County and City Health Officials (NACCHO) NACCHOs vision is health, equity, and security for all people in their communities through public health policies and services. NACCHOs mission is to be a leader, partner, catalyst, and voice for local health departments in order to ensure the conditions that promote health and equity, combat disease, and improve the quality and length of all lives.
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Roundtables
Wednesday, April 10, 2013 7:30 to 8:30 am Breakfast Roundtables
1: Organization
Bluegrass Ballroom 2
Lisa Lang, M.P .P ., Head, National Information Center on Health Services Research, and Assistant Director, Health Services Research Information National Library of Medicine, National Institutes of Health Additional presenters: Karen Dahlen, M.L.S. Paul C. Erwin, M.D., Dr.P.H. Paul Halverson, M.D., M.H.S.A., FACHE 2. Finance Patrick Bernet, Ph.D., Associate Professor of Healthcare Finance Florida Atlantic University College of Business Additional presenters: Simone R. Singh, Ph.D. Jonathon Leider, Ph.D. 3: Technology & Data Eduardo Simoes, M.D., Chair, University of Missouri School of Medicine Department of Health Management and Informatics; National Advisory Committee for PHSSR Member Additional presenters: Susan Cahn, M.P.H., M.A. Roland Gamache, Ph.D., M.B.A. Brian Dixon, Ph.D., M.P.A. 4: Governance Anne Drabczyk, Ph.D., M.A., Chief Executive Officer National Association of Local Boards of Health Additional presenters: Anne Drabczyk, Ph.D., M.A. Scott Hays, Ph.D. Elizabeth Harper, M.P.H. 5: Reducing Health Disparities Francisco Sy, M.D., Dr.P.H., Director of Extramural Activities and Scientific Programs National Institute on Minority Health and Health Disparities, National Institutes of Health 6: PARTNER Network Analysis Tool Danielle Varda, Ph.D., Assistant Professor School of Public Affairs, University of Colorado Denver; secondary appointment in the Colorado School of Public Health, Department of Health Systems, Management, and Policy
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Roundtables
7: State and Local Health Surveys A.J. Scheitler, M.Ed., Coordinator of Stakeholder Relations and Coordinator of the National Network of State and Local Health Surveys UCLA Center for Health Policy Research 8: Sharing Public Health Services Gianfranco Pezzino, M.D., M.P.H., Co-Director Center for Sharing Public Health services, Kansas Health Institute 9: Conducting PHSSR Translation with Health Departments and Practice Ross Brownson, Ph.D., Co-Director Prevention Research Center, Washington University and St. Louis University Public Health PBRN National Advisory Committee Member 10: Research Translation for Policy-Makers Lisa Simpson, M.B., B.Ch., M.P.H., President and CEO, and Kate Papa, M.P .H., Director AcademyHealth 11: Enhancing the Profile Survey Carolyn Leep, M.S., M.P.H., Senior Director of Research and Evaluation National Association of County & City Health Officials 12: Brainstorming With Pracademics Robert Pestronk, M.P .H., Executive Director National Association of County & City Health Officials Public Health PBRN National Advisory Committee Member 13: Measuring Health Equity Katie Sellers, Dr.P .H., CPH, Senior Director, Survey Research, Association of State and Territorial Health Officials 14: Public Health Laboratory Data for PHSSR Eric Blank, Dr.P .H., Senior Director, Public Health Systems, and Deborah Kim, M.P .H., Director, Institutional Research Association of Public Health Laboratories 15: Opportunities for Integration of PHSSR & PHLR Scott Burris, J.D., Director National Advisory Committee for PHSSR Member Jennifer Ibrahim, Ph.D., M.P.H., Associate Director Public Health Law Research program 16: Core Competencies for Public Health Kathleen Amos, MLIS, Project Manager Council on Linkages Between Academia and Public Health Practice, Public Health Foundation 17: PHSSR & Accreditation Jessica Kronstadt, M.P.P., Director of Research and Evaluation Public Health Accreditation Board
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Roundtables
18: Injury Prevention Linda Degutis, Dr.P .H., MSN, Director National Center for Injury Prevention and Control, Centers for Disease Control and Prevention 19: Measuring Capacity of a Membership Network Brittany Bickford, M.P.H., and Sarah McKasson, M.P .H., Evaluation Coordinators National Network of Public Health Institutes
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Plenary Sessions
Wednesday, April 10, 2013 3:45 to 4:45 pm A Formative Evaluation of PHSSR Bluegrass Ballroom 2
Researchers from the Urban Institute present results from their assessment of RWJFs portfolio of PHSSR projects commissioned by the Foundation. Data sources include an environmental scan of published and unpublished materials; surveys of public health practitioners, public health PBRN network partners, and PHSSR grantees; site visits to PBRNs; and key informant interviews. Insights and recommendations will be sought from the audience.
PANELISTS
Randall R. Bovbjerg, J.D. Bovbjerg is a Senior Fellow in the Health Policy Center of the Urban Institute in Washington, DC. He has acquired an unusual combination of research and practical skills during a long career in health policy, including many RWJF projects, numerous evaluations, and many case studies. His specialties include public and private health insurance and reform, public health and workforce issues, the uninsured and the health care safety net, and administrative and legal issues in health care, such as liability and patient safety reform. Other current projects than the PHSSR work to be described at Keeneland include an assessment of opportunities for Community Health Workers under health reform and a case study of recent changes in medical professional regulation in Washington state. His and Hatrys close collaboration began with a 1990s project on nursing regulation, and they recently co-authored Managing and Delivering Performance, for the Journal of Nursing Regulation. Bovbjerg also lead-authored What Directions for Public Health under the Affordable Care Act? and has served as a site-visit assessor for Harvards Innovations in Government Awards. Harry P . Hatry, M.S. Mr. Hatry is a Distinguished Fellow and Director of the Public Management Program at the Urban Institute in Washington, DC. He pioneered tools for measuring program outcomes four decades ago and since then has worked on many public and private sector projects in performance measurement, performance management, and evaluation. Much of his work actively promotes a results focus for local, state, and private nonprofit organization sector. He has contributed to such national efforts as the International City/County Management Associations comparative performance measurement effort; the Governmental Accounting Standards Boards Service Efforts and Accomplishments efforts; the United Way of Americas work to bring outcome measurement into the nonprofit sector; and the Legislating-for-Results initiative of the National Conference of State Legislatures and the National League of Cities. He is a member of the National Academy of Public Administration and the American Evaluation Association, and he received the 1996 Washington Evaluators Award as Evaluator of the Year and the 1985 Elmer B. Staats Award as the years outstanding contributor to management science. He has also written two seminal books on outcome measurement and evaluation, both now in their second editions.
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Plenary Sessions
Thursday, April 11, 2013 9 to 10:30 am Closing Session: Translation and Dissemination
Thoroughbred 1, 2 & 3
One of the main goals of the Keeneland Conference is to encourage the growth of Evidence-Based Public Health (EBPH), either through translation and dissemination of research into practice or practice-based research.
MODERATORS
Ross Brownson, Ph.D. Prevention Research Center/Washington University and St. Louis University Public Health PBRN National Advisory Committee Member Paul Erwin, M.D., Dr.P.H. University of Tennessee Co-Investigator of the National Coordinating Center for PHSSR Drs. Paul Erwin and Ross Brownson will co-moderate the closing session, with Dr. Brownson leading off with an overview of his multi-pronged LEAD-PH research project on EBPH, including early results. The Robert Wood Johnson Foundation has funded Dr. Brownson and his team at Washington University in St. Louis to explore evidence-based decision-making in local health departments.
PRESENTERS
Practitioner: Beth Gyllstrom, Ph.D., M.P.H., Minnesota Department of Health Researcher: Bill Riley, Ph.D., University of Minnesota All Minnesota local health departments (LHDs) received funding in 2009 to implement policy, systems and environmental (PSE) change interventions within their communities. This study examines factors at the LHD level that contribute to success in implementing these strategies. The primary study hypothesis is that increased local public health capacity and performance (as measured by authority level of the top local public health official, maturity of organizational quality improvement (QI), readiness for accreditation and participation in intervention-specific QI activities) improves LHD performance on PSE strategies (ability to meet stated goals; depth of implementation; sustainability of strategies). Practitioner: Marie Flake, M.P.H., Washington State Department of Health Researcher: Betty Bekemeier, Ph.D., M.P.H., RN, University of Washington Through partnerships with practitioners and Public Health Practice-Based Research Networks (PBRN), the Public Health Activities and Services Tracking (PHAST) study is providing a comprehensive, accessible database for answering practice-based research questions. In a Washington (WA) partnership, we compiled annual LHD financial data from 1993 to 2010, to examine trends over time and differences among Washingtons 35 LHDs and in relation to other local characteristics. Specific visual displays of data were collaboratively created between researchers and practitioners to maximize relevance and accessibility for practice leaders. These existing detailed data have thus become a meaningful planning tool to support effective health policy and data-driven financial planning.
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Plenary Sessions
Practitioner: Chris Maylahn, M.P.H., New York State Department of Health Researcher: Britney Johnson, M.P.H., The State University of New York at Albany, School of Public Health Integrated HIV/AIDS and STD Service Delivery in New York: A Natural Experiment: The New York PBRN aims to identify and test valid and reliable measures of quality associated with delivery of HIV/AIDS and STD services by local public health agencies, and then use these measures as part of a natural experiment to evaluate the impact of a statewide initiative to integrate the delivery of these two service lines. This project will assess the impact of the integration process on staff attitudes and job satisfaction, client awareness and utilization of services, and service quality based on adherence to evidence-based practices. Results of this study will yield validated measures for assessing the quality of HIV and STD service delivery, as well as other efforts to integrate public health service programs. Practitioner: Colleen Bridger, Ph.D., Orange County Health Department, North Carolina Researcher: Lisa Harrison, M.P.H., Vance District Health Department, North Carolina Last year the North Carolina Institute of Medicine (NC IOM) established the Task Force on Implementing Evidence-Based Strategies in Public Health and completed their report in September 2012. The Task Force was charged with developing recommendations to assist public health professionals in the identification and implementation of evidence-based strategies within their communities to improve population health. Dr. Bridger and Ms. Hill both served on the Steering Committee for this Task Group, and as local health department directors are now working to implement the recommendations described in the report. One of the recommendations called for local health department directors to select two evidence-based strategies for implementation, and this recommendation is in the state-LHD agreement documents. Thus, we will hear from the front-lines on what may be the first experience with codifying EBPH for use in LHDs. View the report, (http://bit.ly/EBPH100912.).
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Concurrent Sessions
SESSION 1A: Workforce I-Tuesday, April 9, 2013, from 2 to 3:15 pm
Room: Thoroughbred 1
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Concurrent Sessions
SESSION 1A: Workforce I-Tuesday, April 9, 2013, from 2 to 3:15 pm
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Concurrent Sessions
SESSION 1A: Workforce I-Tuesday, April 9, 2013, from 2 to 3:15 pm
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Concurrent Sessions
SESSION 1B: Consolidation-Tuesday, April 9, 2013, from 2 to 3:15 pm
Room: Thoroughbred 2
Insights and Issues Relating to Assessing the Impacts of Health Department Consolidation
Co-Investigators: Aimee Budnik, M.S.; Tegan Beechey, M.P.A.; Josh Filla, M.P.A. Research Objective: To document perceived outcomes associated with the consolidation of health departments in Summit County, Ohio, one year after its implementation. The information presented can assist local public health systems in understanding the impacts of consolidation and researchers in conducting evaluative studies of health department consolidation. Data Sets and Sources: The study team reviewed literature and documents on the Summit County health department consolidation, interviewed public health stakeholders, and surveyed employees of the newly consolidated health department. In total, feedback on the consolidation and its impacts was solicited from about 300 individuals with knowledge and experience relating to the consolidation. Study Design: The study presents descriptive information on challenges in implementing the consolidation, the impacts of the consolidation, and variations in perceptions among stakeholders, managers, and employees. The data collected are designed to lend insights on the process and impacts of consolidation and variations in perceptions of those involved in the process. Analysis: The data collected are analyzed qualitatively to identify key challenges, and quantitatively to describe likely impacts and variations in perceptions relating to these impacts. While the analyses completed to date are primarily descriptive, additional statistical analyses may be conducted to identify predictors of support for consolidation across key audiences. Principal Findings: The consolidation saved $1.5 million during its first year of implementation. While the study revealed multiple perspectives, it generally suggested that baseline services had been maintained during the transition to a consolidated department, and that the consolidation holds the potential to improve public health services and capacities in the future. Conclusion: Consolidating health departments is difficult, but Summit County has made progress in addressing operational and strategic challenges, saving money, and re-examining strategies for public health services in the county. In addition, many of those contacted expressed optimism about the potential for future improvements in public health capacities and services. Implications for the Field of PHSSR: The analyses presented offer helpful insights to other researchers undertaking efforts to understand health department consolidation, as well as to practitioners who may be involved in considering or implementing consolidations. The presentation will discuss the analytical processes undertaken by the project team and the challenges associated with its methodologies.
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Concurrent Sessions
SESSION 1B: Consolidation-Tuesday, April 9, 2013, from 2 to 3:15 pm
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Concurrent Sessions
SESSION 1B: Consolidation-Tuesday, April 9, 2013, from 2 to 3:15 pm
Analysis: A mixed methods approach to data analysis using qualitative and quantitative data. Financial analysis and qualitative content analysis of job descriptions, organizational structures and Ohio public health law were completed. Internal and external satisfaction surveys were analyzed. Principal Findings: The Feasibility Study identified a proposed governing structure; fiscal requirements; personnel and programmatic disparities of the new organization; importance of obtaining community input; and staff participation in the process. The retrospective analysis of the consolidation identified disparities in perceptions among the workforce. The financial analysis identified a cost savings. Conclusion: The use of data can be informative as well as a significant catalyst for change. The results from the Feasibility Study provided evidence that was needed to successfully move forward in a consolidation. The data from the Retrospective Evaluation provided areas for the leadership to focus its attention. Implications for the Field of PHSSR: There is a need for these types of collaborations among public health departments, academic institutions, and political and community organizations to improve the public health system. The use of data can be an important part of organizational decision-making when public health departments are considering the need to consolidate within communities.
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Concurrent Sessions
SESSION 1C: Finance -Tuesday, April 9, 2013, from 2 to 3:15 pm
Room: Thoroughbred 3
Local Health Department Expenditures on Maternal/Child Health Impact Health Outcomes: Findings From PHAST and for Advancing Policy Discussions
Co-Investigators: Youngran Yang, Ph.D., M.P.H., RN; Michael Morris, Ph.D., M.P.H.; Matthew Dunbar, Ph.D.; David Grembowski, Ph.D., M.A. Research Objective: In connection with the Public Health Activities and Service Tracking (PHAST) study and in collaboration with Public Health Practice-Based Research Networks (PBRN), we examined annual maternal/child health (MCH) expenditures for 102 LHDs from 2000-2010. Our purpose was to investigate the relationship between LHD expenditures on MCH services and related health outcomes. Data Sets and Sources: Unpublished annual LHD expenditures, obtained from state health departments in Washington and Florida, represented financial investments in three MCH service areas. These data were linked with county-level sociodemographic controls and MCH outcomes. Outcomes included no/late prenatal care rates, births to females age 15-19, low birth weight, and infant mortality (IMR). Study Design: We used a multivariate panel-time series design using robust standard errors to statistically estimate the ecologic associations between these MCH expenditures by LHDs and related outcomes over 11 years, while controlling for other factors. Three-year smoothed rates of each outcome variable were compared to the previous years expenditures. Analysis: Three-year smoothed rates of each outcome were compared to previous years expenditures and examined for relationships to health, while controlling for other factors. Stratified analyses were conducted with jurisdictions categorized as poor (among a states top one-third most impoverished counties) and non-poor (the two-thirds counties with lower poverty rates). Principal Findings: Outcomes were consistently in the expected, beneficial directions, but with the most significant relationships indicated in non-poor counties. The strongest beneficial relationships were indicated among the more targeted expenditures i.e. each program-specific expenditure (such as for WIC and Family Planning). The least strong relationships existed with overall, total LHD expenditures. Conclusion: Relationships exist between an LHDs MCH expenditures and outcomes. This relationship appears stronger in more affluent communities where targeted MCH services may have more of an impact on populations that already have greater health advantages, versus where other unmeasured community factors impede the effect of these services in impoverished jurisdictions. Implications for the Field of PHSSR: Findings have policy implications suggesting that expenditures by LHDs on MCH-related services do have a beneficial relationship with important health indicators. Researchers using detailed, program-specific data may produce stronger, more focused findings for practice and policy decision-making.
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Concurrent Sessions
SESSION 1C: Finance -Tuesday, April 9, 2013, from 2 to 3:15 pm
Concurrent Sessions
SESSION 1C: Finance -Tuesday, April 9, 2013, from 2 to 3:15 pm
Analysis: Quantitative data collected through financing templates were explored for key themes and trends across program areas and localities. Qualitative data collected through semi-structured interviews were grouped by key theme. Principal Findings: Study findings noted variation in how state and local public health agencies report expenditures and revenues, specifically variations in inclusion and exclusion criteria, among other issues. Examples include challenges defining public health and program areas; superagency structure issues; defining fiscal years and budgets; and distinguishing state money versus federal flow-through. Conclusion: With increased demands for accountability of public resources, budget constraints resulting from the recent economic downturn, and shifting demands arising from the passage of the Affordable Care Act, it is imperative for public health stakeholders to understand and track financing processes and allocations to facilitate well-informed decision-making and resource prioritization. Implications for the Field of PHSSR: These issues have important implications: Limitations of currently available financing data affect public health practitioners, researchers, and policy-makers as they define effective and efficient decision-making processes for public health resource allocations. Consistent terminology and clearly defined categories can help ensure that public health data be easily compared across jurisdictions.
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SESSION 1D: Partnerships-Tuesday, April 9, 2013, from 2 to 3:15 pm
Moderator: Carmen Nevarez, M.D., M.P.H. Vice President for External Relations and Preventive Medicine Advisor Public Health Institute National Advisory Commttee for PHSSR Member Kusuma Madamala, Ph.D., M.P.H.
Shared Service Arrangements Among Local and Tribal Health Departments in Wisconsin
Co-Investigators: Nancy Young, M.P.A.; Dustin Young, B.A.; Lieske Giese, M.S.P.H., B.A., RN; Dan Stier, J.D.; Terry Brandenburg, M.B.A., M.P.A.; Susan Zahner, Dr.P.H., RN Research Objective: Explore current and future use of shared service arrangements as a management strategy to increase capacity to provide public health essential services in Wisconsin. Data Sets and Sources: Select variables from the 2010 Wisconsin Local Health Department survey were merged. Other data sources included results from a Board of Health governance analysis and the Wisconsin Department of Health Services region data. Study Design: Online cross-sectional survey of 99 local and tribal health departments in Wisconsin Analysis: Ninety-one of 99 Wisconsin local and tribal health departments responded, yielding a 92% response rate. Descriptive analysis was performed of current and future shared service arrangements and the characteristics of the types of arrangements and agreements in place. Principal Findings: Seventy-one percent of respondents share services with one or more LHDs, with more frequent arrangements in programmatic areas than in departmental operations. Motivators include making better use of resources, providing better services, and responding to program requirements. Findings indicate arrangements accomplished what was intended, with perceived gains in efficiency and effectiveness. Conclusion: There is widespread use of shared services among health departments in Wisconsin. Extensive qualitative comments suggest participant satisfaction with what the arrangements have accomplished. Motivating factors in developing the arrangements and limited mention of expiration dates suggests continued study of how these arrangements may evolve. Implications for the Field of PHSSR: Further examination of shared services as a potential mechanism to advance service effectiveness and efficiency is needed. Potential research questions include: How do shared service arrangements change over time? What are emerging drivers? What evidence exists to support the perception of gains in efficiency and effectiveness resulting from shared services?
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Concurrent Sessions
SESSION 1D: Partnerships-Tuesday, April 9, 2013, from 2 to 3:15 pm
Research Objective: The research objective was two-fold: understand the impact of the federally funded Beacon Communities Program (BCs) on public health agency information infrastructure in funded communities; identify and document methods and practices with demonstrated results for translation and dissemination to the public health practice community. Data Sets and Sources: Qualitative data were collected through semi-structured interviews with key informants and focus groups with intervention participants. Additional artifacts were collected from sites, such as annual reports, advisory committee minutes and evaluation reports. Quantitative data on intervention outcomes were available from BCs through their evaluation activities. Study Design: Mixed-methods nested case study design was used; six BCs included were determined to have substantive public health activities. Individual case studies and nested case studies were developed to draw conclusions within and across communities to ascertain impacts of public health agency involvement in BCs on their systems and infrastructure. Analysis: NVIVO software was used to organize, code and analyze qualitative data. Standard practices were used for codebook development and document coding. Additional analysis of quantitative data was not required. Data triangulation was employed to validate findings among data sources both within individual cases and across all cases. Principal Findings: Public health agencies that had meaningful involvement in Beacon Community information technology (health IT) and health information exchange (HIE) initiatives led to improvements in public health systems and information technology infrastructure, reach of population health services, and coordination with health care providers in their communities. Conclusion: Active participation of public health agencies in state and local health IT and HIE initiatives is vital to ensuring public health priorities are addressed. Involvement in these initiatives strengthens public health systems through enhanced ability to provide population health services and monitor health trends in communities. Implications for the Field of PHSSR: Health IT and HIE offer significant opportunities for PHSSR both as important sources of population health outcomes data and as a field of study to understand how public health agencies can leverage these community resources to strengthen infrastructure and better communicate and collaborate with the health care system.
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Concurrent Sessions
SESSION 1D: Partnerships-Tuesday, April 9, 2013, from 2 to 3:15 pm
Principal Findings: The analyses revealed that SPHAs focus on setting and achieving both internal and external strategic directions and priorities. In addition to improving internal processes and achieving outcomes, SPHAs focus on better outreach and communication to key constituents. Conclusion: SPHAs are moving ahead and undertaking comprehensive, yet targeted strategic planning efforts in a challenging and changing environment. Effective communication and resource management and identification are key. Continued research in these areas would benefit these strategic efforts. Implications for the Field of PHSSR: Identifying the priorities and strategies on which SPHAs are focused provides a framework against which researchers can relate and interpret accomplishments and outcomes they discover. This will also help guide and inform future directions for research. Explicitly making these connections in the research world will help inform SPHA strategic efforts.
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Concurrent Sessions
SESSION 1E: Technology & Data I-Tuesday, April 9, 2013, from 2 to 3:15 pm
Moderator: Michele Issel, Ph.D. Clinical Professor in the Community Health Sciences Division of the School of Public Health University of Chicago Mary Jo Baisch, Ph.D., RN
The Status of LHD Information Systems: A Critical Need for Coordination to Inform Meaningful Health Improvement Initiatives
Co-Investigators: Jeanette Olsen, M.S.N., RN (presenting); Nancy J. Kreuser, Ph.D., M.S.N., RN Research Objective: The examination of information systems and standard terminologies among LHDs is critical for discerning priority public health informatics initiatives and interventions. A statewide study was conducted to identify information systems and standard terminologies used to describe public health practices in LHDs, and explore LHD leaders perceptions of existing systems. Data Sets and Sources: Adapted from the 2010 Oregon Health Information Technology Oversight Councils survey of LHDs, an electronic survey was disseminated to Wisconsin LHD health officers/directors (N=88) in December 2012. Response rate: 75% (n=66). Study Design: Using a cross-sectional, descriptive design, the questionnaire was used to collect both quantitative and qualitative data: numbers and types of information systems utilized in local health departments and LHD staffs perceptions of their utility, respectively. Analysis: Descriptive statistics were used to analyze the number of systems in use, level of satisfaction with current systems, and use of standard terminologies to describe practices. Qualitative, thematic analysis was used to analyze narrative survey responses regarding challenges, needs, priorities and plans. Principal Findings: Eighty-five systems were used by one or more LHDs; only four were used by 94-100% of departments. Four standard terminologies were used: ICD9(25%), CPT(14%), ICD10(8%), and OMAHA(8%). Deficiencies and challenges: lack of system integration/intercommunication; need for outcomes data that captures public health work; and need for training and/ or user-friendly systems. Conclusion: Findings indicate that there is a clear and urgent desire among LHDs for integration and coordination of information systems, training and funding, so that they can provide state public health leaders with specific, meaningful data that can be used to guide informatics initiatives and interventions and influence state-level budget and policy decisions. Implications for the Field of PHSSR: This study is aligned with the Public Health Information and Technology area of the National Research Agenda for PHSSR. Specifically, it contributes to the knowledge base needed to inform initiatives to advance capabilities, to assess and monitor health outcomes, and improve communication technologies.
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Concurrent Sessions
SESSION 1E: Technology & Data I-Tuesday, April 9, 2013, from 2 to 3:15 pm
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Concurrent Sessions
SESSION 1E: Technology & Data I-Tuesday, April 9, 2013, from 2 to 3:15 pm
Analysis: Data analysis followed a general inductive approach. Independently, we read the transcripts and employed open coding to identify tentative themes within the data. Principal Findings: Interviews reported inefficient activities like duplicate data entry; manually counting records; searching for individuals in multiple non-interoperable IS; or faxing records even when a supposedly shared IS existed. This took employees away from other activities or slowed data sharing between organizations. To fulfill data needs, practitioners constructed workarounds and make-work. Conclusion: LHDs face a challenge in both meeting the data needs of practitioners and turning data into information for action. LHDs do need to increase organizational capabilities around data management and rely less on paper records and forms. Implications for the Field of PHSSR: LHDS and SHAs must also work collaboratively to ensure their respective IS are interoperable and that policies are in place to ensure end user accessibility of data in shared IS.
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Concurrent Sessions
SESSION 2A: Preparedness-Wednesday, April 10, 2013, from 9 to 10:15 am
SESSION 2-WEDNESDAY, APRIL 10, 2013 FROM 9 TO 10:15 am SESSION 2A: Preparedness
Moderator: Jennifer Ibrahim, Ph.D., M.P.H. Associate Director Public Health Law Research Program Mary Davis, Dr.P.H., M.S.P.H.
Creating a Preparedness Index, Easier Said Than Done
Co-Investigators: Christine Bevc, Ph.D., M.A.; Anna Schenck, Ph.D. Research Objective: This presentation will discuss the benefits, limitations and implications associated with the use of preparedness measures indices. Previous composite measures often assume equal variable weighting, discounting relationships among variables. Simple additive indices unduly penalize those organizations with fewer capacities, as well as those organizations that reported greater number of capacities. Data Sets and Sources: Using longitudinal data collected by the LHD Preparedness Capacities Survey (P-CAS), this analysis will examine the preparedness capacities of 85 local public health agencies in North Carolina and a matched comparison group of 248 public health agencies. Study Design: Two years of survey data will be used to examine changes in local preparedness capacities over time and examine the relationship among local characteristics and preparedness. Testing various preparedness analysis methodologies will help us understand the impact that performance measurement systems and tools can have on public health strategies. Analysis: Data will be used to examine changes in local preparedness capacities over time and examine the relationship among local characteristics and preparedness. Detailed analysis of preparedness capacities will examine varying index methodologies and calculations to illustrate differences in preparedness levels and, subsequently, varying potential policy decisions. Principal Findings: Results found significant differences among calculations in multiple preparedness domains, including surveillance, communication, workforce, plans/protocols, and legal infrastructure. Conclusion: These findings will advance preparedness measurement for health departments to help track and improve performance. These findings translate more broadly to ongoing efforts to define a Public Health Preparedness Index. Implications for the Field of PHSSR: This presentation will help us to better understand the impact that performance measurement systems and performance management tools can have on public health strategies delivered at local, state, and national levels. The findings serve to advance the measurement and scoring methods and models for public health strategies.
Room: Thoroughbred 1
Concurrent Sessions
SESSION 2A: Preparedness-Wednesday, April 10, 2013, from 9 to 10:15 am
Data Sets and Sources: Our set of translational tools was created using the findings from legal analyses conducted by our project team. The sources for our legal research included legislation, regulation, judicial opinions, and guidance documents from U.S. federal, state, and local governments. Study Design: In consultation with a Project Advisory Group (PAG) consisting of lawyers, ethicists, and public health practitioners, we identified key legal topics to analyze (e.g., deployment of mental health professionals in emergencies). For each legal topic we researched, we drafted an accompanying translational tool. Analysis: We created a set of eight translational tools. Each tool was vetted by PAG members from multiple disciplines (e.g., mental health, law, preparedness), and revised to incorporate their feedback. The tools are intended to promote emergency preparedness for mental and behavioral health within the public health system. Principal Findings: Law has the potential to both enhance and obstruct emergency response and recovery efforts. Our translational tools address this concern by providing information and recommendations in areas such as prescribing authority; liability for health care professionals; disability rights; and substance abuse treatment. Conclusion: Some aspects of the legal environment relative to mental and behavioral health may pose challenges within the public health system, especially during and after emergencies. Through our legal research, we identified and analyzed several areas of importance to public health practitioners. Our translational tools offer brief analyses and recommendations. Implications for the Field of PHSSR: Within the public health system, many professionals have no legal training. We created a set of translational tools regarding legal preparedness specifically for these individuals. The tools were vetted by a multidisciplinary group, containing several members with no legal training. The tools will be made available during the presentation.
Concurrent Sessions
SESSION 2A: Preparedness-Wednesday, April 10, 2013, from 9 to 10:15 am
Conclusion: Our research shows that public health emergency response team performance depends to a certain degree on who the leader is during the response/exercise. To effectively train and prepare response teams, it is essential to understand how nontechnical skills, behavioral markers, and leadership interact and impact team performance and high reliability. Implications for the Field of PHSSR: The intervention may be less important in improving response team performance than the leader and his training and experience. No study of leaders at the micro-system level exists with respect to behavioral markers necessary to achieve high reliability in crisis settings. Our data and findings provide insight into that process.
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Concurrent Sessions
SESSION 2B: Translation I-Wednesday, April 10, 2013, from 9 to 10:15 am
Room: Thoroughbred 2
Are the Principles of Partnership for Community-Based Participatory Research Useful for Practice-Based Participatory Research?
Co-Investigators: Betty Bekemeier, Ph.D., M.P.A., RN; Anna Hoover, M.A.; Nancy Winterbauer, Ph.D., M.S. Research Objective: This study examined Principles of Partnership for Community-Based Participatory Research (CBPR) in the context of Public Health Practice-Based Research Networks (PH PBRNs). Objectives were to explore the relevance of the nine CBPR principles (Israel et al., 2003) to public health practice-based research partnerships and their potential to strengthen practice-academic partnerships. Data Sets and Sources: An expert panel of PH PBRN leaders from four states was convened. Data sources included Barbara Israel and colleagues seminal works on CBPR (1998, 2003); historic documents from the National Coordinating Center for PBRNs; and the authors experiences in CBPR, practice-based participatory research (PBPR), and PH PBRNs. Study Design: The study is grounded in various theories of participation, including theories of power, empowerment, and community participation. The project was designed as an expert panel review and included panelists with substantial knowledge and experience in public health practice, research, multi-stakeholder engagement, and PBPR. Analysis: Analysis was based on iterative discussion and consensus decision-making, common participatory techniques. Principal Findings: The CBPR Principles of Practice are useful to PBPR both in terms of process (reflections on principles and practice) and as strategies for partnership development and strengthening. Principles of equity, co-learning and capacity-building, dissemination, and commitment emerged as particularly significant to partnership development in PH PBRNs. Conclusion: Results indicated that with the flexibility inherent and intended in CBPR, the guidelines are generally useful for partnership building in PH PBRNs. Additionally, the process of examining CBPR Principles of Partnership in the context of PBPR proved enlightening by prompting deep consideration of frequently taken-for-granted aspects of both CPBR and PBPR. Implications for the Field of PHSSR: Existing PH PBRNs wishing to strengthen their practice-academic partnerships, as well as individuals and coalitions interested in developing PH PBRNs, are likely to find CBPR guidelines helpful in building and sustaining their networks. PH PBRN collaborators exploring the comparison as a group may find the exploration itself useful for strengthening their partnerships.
Concurrent Sessions
SESSION 2B: Translation I-Wednesday, April 10, 2013, from 9 to 10:15 am
and academia, emphasizing tensions between practitioners and researchers, benefits, and opportunities for interdisciplinary bridges. Data Sets and Sources: Data consist of qualitative interviews with individuals identified as pracademics. For the purposes of this study, pracademics were defined as individuals with professional experience in both academic and public health practice roles. Study Design: Recruitment began with six individuals known to the investigators to meet the study definition of a pracademic. At the conclusion of the qualitative interviews, participants identified additional individuals meeting the study definition (chain referral). Purposive sampling ensured a reasonable mix of Public Health Practice-Based Research Network (PH PBRN) and nonPH PBRN respondents. Analysis: We conducted a qualitative descriptive study using content analysis. Our initial coding scheme was informed by the literature and our own experience. Themes were identified based on repeated and close reading of transcripts. Rigor was enhanced by participation of two investigators in qualitative data collection, coding and interpretation. Principal Findings: Major themes included the recognition that public health academic researchers and practitioners inhabit two distinct cultural worlds. Differences are apparent in the language, values, identity, and time-sensitivity of each group. Nonetheless, participants valued these relationships and offered a variety of suggestions for improving relationships between academics and practitioners. Conclusion: Public health practitioners and academics differ in a number of important ways that present challenges to practiceacademic research partnerships. However, recognition of these differences, along with a commitment to actively identify opportunities to strengthen collaboration, will benefit academic researchers, practitioners and public health practice. Implications for the Field of PHSSR: A number of tensions exists between public health academic researchers and practitioners. Individuals working in practice-based, public health services and systems research could enhance their work by recognizing and attending to these tensions by identifying opportunities to strengthen academic-practitioner relationships.
Concurrent Sessions
SESSION 2B: Translation I-Wednesday, April 10, 2013, from 9 to 10:15 am
Conclusion: Descriptions and analysis of the perceived level of engagement within and across AHD dyads will add new understanding of facilitators and barriers to the development of sustainable, vital, and mutually beneficial AHD partnerships. Implications for the Field of PHSSR: AHDs have the potential to be a community engagement exemplar in which the partners work together to address the plethora of current, emerging, and future challenges and opportunities associated with health, the delivery of public health services, and the development and maintenance of an effective public health workforce and pipeline.
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Concurrent Sessions
SESSION 2C: Organization-Wednesday, April 10, 2013, from 9 to 10:15 am
Room: Thoroughbred 3
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Concurrent Sessions
SESSION 2C: Organization-Wednesday, April 10, 2013, from 9 to 10:15 am
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Concurrent Sessions
SESSION 2C: Organization-Wednesday, April 10, 2013, from 9 to 10:15 am
Analysis: We analyzed North Carolina laws to identify differences in LPHA structure and governance. Focus groups and key informant interviews identified stakeholders perceptions of the benefits and challenges of each LPHA type. We performed descriptive statistical analyses on publicly available data to compare LPHA types on finance, workforce, and service delivery measures. Principal Findings: Laws for governing boards, directors, personnel, and budget/finance vary by LPHA type. Stakeholders reported benefits and challenges of all LPHA types. LPHA types differ in sources of funding, especially percentage of funding from county appropriations. Expenditures and FTEs were lower for LPHAs serving larger populations, regardless of agency type. Conclusion: Types of LPHAs in North Carolina are not entirely distinct from one another, and there was wide variation within categories of LPHAs. Nevertheless, we found important differences among our states LPHA types that are relevant to policymakers with responsibility for local public health systems. Implications for the Field of PHSSR: Some states are considering restructuring LPHAs in hopes of achieving long-term efficiencies. North Carolinas experience in operating different types of LPHAs (single- and multi-county health departments, public health authorities, consolidated human services agencies) can provide valuable information to policy-makers who are examining how best to organize their local public health systems.
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Concurrent Sessions
SESSION 2D: Quality Improvement I-Wednesday, April 10, 2013, from 9 to 10:15 am
Defining and Measuring Quality Improvement in Public Health: Experience From CDCs National Public Health Improvement Initiative
Co-Investigators: Saira Nawaz, Ph.D.; Andrea Young, Ph.D.; Craig Thomas, Ph.D. Research Objective: To develop a standardized approach to categorizing and measuring outcomes of public health quality improvement (QI) initiatives in order to assess gains in efficiency and effectiveness associated with the Centers for Disease Control and Preventions National Public Health Improvement Initiative (NPHII). Data Sets and Sources: The identification of public health QI outcomes was based on a review of existing literature and an analysis of QI activities and performance measures developed by NPHII awardees during the programs second year. Literature reviewed included peer-reviewed and web-based sources on QI, defining public health quality, and performance measurement. Study Design: Introduce a standardized measurement framework for public health QI outcomes. Outcomes were categorized into two measurement constructs efficiency and effectiveness. Efficiency outcomes include time saved, money saved, and revenue generated. Effectiveness outcomes include increased customer satisfaction, increased reach, funds leveraged, quality enhancement, increased preventive behaviors, and decreased disease incidence/prevalence. Analysis: Based on the measurement framework, NPHII awardees submitted performance measures for their year three QI projects. CDC staff reviewed these measures to determine the efficacy and utility of the standardized measurement framework; breadth of intended outcomes for awardee QI projects; and the technical accuracy of the measures for each outcome. Principal Findings: Sixty-six NPHII awardees defined 330 performance measures to assess intended outcomes of 177 QI initiatives. Across these initiatives, all categories of outcomes were adopted and measured, with the most frequently reported intended outcomes being quality enhancement (31.82%), increased reach (13.03%), time saved (13.94%), and increased customer satisfaction (11.51%). Conclusion: This approach to categorizing QI outcomes and standardizing the approach to measurement of these outcomes for NPHII has resulted in a robust set of QI projects and associated measures. As data are submitted on the measures, an analysis of successes and challenges and refinements to the approach will be important. Implications for the Field of PHSSR: To understand the impact of QI in public health, it will be necessary to aggregate outcomes from discrete, context-specific projects. This work represents an initial attempt to define outcomes that apply to diverse public health processes, programs, and services along with a framework to standardize measurement of these outcomes.
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Concurrent Sessions
SESSION 2D: Quality Improvement I-Wednesday, April 10, 2013, from 9 to 10:15 am
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Concurrent Sessions
SESSION 2D: Quality Improvement I-Wednesday, April 10, 2013, from 9 to 10:15 am
Study Design: This study is a cross-sectional descriptive study to measure the quality of Wisconsins local health departments CHIPPs. Based on Public Health Accreditation Board Standards and literature review, the CHIPP Quality Measurement Tool was created and reviewed by practice-based experts. It was then used to measure the quality of Wisconsins CHIPPs. Analysis: Univariate descriptive analyses of each measure within the CHIPP Quality Score were conducted. Measures were added to produce a component score, and similar analyses were calculated for each component. All component scores were weighted and added to create a CHIPP Quality Total Score, and similar univariate analyses were conducted. Principal Findings: Forthcoming. The tools validity has been confirmed by LHD directors confirmation of the scores. Initial findings indicate the components of evidence-informed strategies and assessment have the highest quality ratings and the components of implementation and evaluation have the lowest quality ratings. Conclusion: Quality improvement begins by defining quality standards. This study advances quality improvement efforts for a core public health function by creating a quality measurement tool and establishing baseline quality measurement scores for Wisconsins CHIPPs. The tool can be used by practitioners as a self-assessment for real-time measurement of CHIPP quality. Implications for the Field of PHSSR: The next phase of this study will determine if any structural or process factors influence CHIPP quality. Future studies that measure the relationship between CHIPP quality and health outcome improvements will determine the added value of this public health practice. This study provides a baseline for this type of analysis.
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Concurrent Sessions
SESSION 2E: Technology & Data II-Wednesday, April 10, 2013, from 9 to 10:15 am
Moderator: Eduardo Simoes, M.D., M.Sc., M.P.H. Chairman & Health Management and Informatics Alumni Distinguished Professor University of Missouri National Advisory Committee for PHSSR Member Jeffrey "Mac" McCullough, M.P.H.
Local Health Department Adoption and Discontinuation of Electronic Medical Records
Co-Investigators: None named. Research Objective: Relatively little is known about predictors of adoption and abandonment of health IT by local health departments (LHDs). Thus this study examined factors associated with the use of electronic health records (EHR) by LHDs in 2010, and to examine predictors of EHR adoption or abandonment between 2005 and 2010. Data Sets and Sources: This study uses LHD data from two waves of the National Association of City and County Health Officials (NACCHO) Profile Surveys - 2005 and 2010. There are 105 LHDs with relevant data for both 2005 and 2010 and hundreds more with data from one of the two waves. Study Design: This study uses a repeated cross-sectional design of data from 2005 and 2010 for a set of LHDs that received the NACCHO survey questionnaires in both years. The studys conceptual framework posits that adoption and abandonment are explained by resource-based factors (e.g., clinical services). Analysis: Dichotomous measures of adoption and abandonment were created for each LHD. Control variables were selected through literature review. All data came from NACCHO Profile Surveys. Logistic regression models were used to assess predictors of adoption and abandonment. Principal Findings: LHDs both adopted and abandoned EHR between 2005 and 2010. In logistic regression models predicting adoption or abandonment, very few variables were significant. Where adoption or abandonment occurred, clinical services do not appear to be the only driver of the transition. Conclusion: Factors beyond resource-based considerations (e.g., services offered) appear to be partially responsible for LHD adoption and abandonment of EHRs from 2005 to 2010. There is likely to be an important role for LHD leaders to play in these decisions; leadership should be attuned to these issues at their own departments. Implications for the Field of PHSSR: LHD leadership plays a critical role in the decision to adopt (or not) and abandon (or not) EHR in their departments. These considerations may vary for each department, but there is likely substantial value in the lessons learned that should be disseminated among organizations.
Concurrent Sessions
SESSION 2E: Technology & Data II-Wednesday, April 10, 2013, from 9 to 10:15 am
Data Sets and Sources: Three different types of codes are automatically extracted from three different textual document data sets: 1) ICD-9-CM diagnosis codes from textual narratives in EMRs; 2) ICD-O-3 topography codes from pathology reports; 3) ECRF purpose, subject, and response codes from cancer information service LiveHelp chat transcripts. Study Design: Codes were extracted using supervised and unsupervised machine learning methods. To compare the accuracy of computational techniques with trained human coder extraction, our data sets were already coded by humans. In the supervised case, each data set was split into training (used in the learning phase) and testing subsets. Analysis: The evaluation was conducted using the counts of true positives (TP), false positives (FP), and false negatives (FN) computed by comparing codes from automated methods with those extracted by human coders. Precision = TP/(TP+FP), Recall = TP/(TP+FN), and F-score = 2*P*R/(P+R) were used as the measures of quality of automation. Principal Findings: The number of unique codes in each data set: 633 ICD-9-CM codes, 57 ICD-O-3 codes, and 31 CIS ECRF codes. We obtained F-scores (maximum of 1) of 0.47 for ICD-9-CM code extraction, 0.9 for ICD-O-3 code extraction, and 0.7 for ECRF code extraction using completely automated methods. Conclusion: These findings demonstrate a strong potential of automated methods to assist human coders in expediting their work in code extraction in health care, saving time and reducing financial burden. Furthermore, they also offer a near real-time analysis of the patient conditions in a health care facility. Implications for the Field of PHSSR: Syndromic surveillance and rapid case ascertainment are important components of public health services research. As such, automatic code extraction methods have direct impact on building public health systems that automatically report unusual spikes in patient conditions across a region through aggregation of such information from individual care facilities.
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Concurrent Sessions
SESSION 2E: Technology & Data II-Wednesday, April 10, 2013, from 9 to 10:15 am
Conclusion: Policy decisions regarding delivery of health care have implications for public health. While technical quality improvement initiatives in clinical care are characterized by more timely access to information, reduced medical errors and increased cost savings, it is unknown whether these clinical care improvements translate into quality improvements for public health. Implications for the Field of PHSSR: Evidence is lacking on whether and how clinical technological interventions and policies regarding delivery of health care support public health quality and process improvements. This study will provide evidence of the impact of health care policy decisions on public health.
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Concurrent Sessions
SESSION 3A: Technology & Data III-Wednesday, April 10, 2013, from 10:45 am to 12 pm
SESSION 3-WEDNESDAY, APRIL 10, 2013 FROM 10:45 am TO 12 pm SESSION 3A: Technology & Data III
Moderator: Vincent La Fronza, Ed.D., M.S. CEO National Network of Public Health Institutes Carolyn Leep, M.P.H., M.S., B.S.
Local Health Department Jurisdiction Changes: 2005 to 2012
Co-Investigators: Jiali Ye, Ph.D.; Nathalie Robin M.P.H., B.S.; Jan Wilhoit, B.A. Research Objective: To identify and characterize changes in jurisdictions of locally-governed local health departments (LHDs), in terms of types of jurisdiction changes and net changes in number of LHDs from 2005 to 2012. Data Sets and Sources: This study used the study population files for the 2005, 2008, 2010 and 2013 National Profile of Local Health Department studies. State-governed LHDs and LHDs in Texas were excluded from this analysis. Study Design: Lists of LHDs were compared for each state to identify jurisdiction changes between each Profile cycle. Telephone interviews were conducted with state representatives knowledgeable about jurisdiction changes in those states with the largest number of changes to confirm changes and obtain information about reasons for changes. Analysis: Each jurisdiction change was coded as a merger, absorption, de-merger, or separation. The net change (positive or negative) in number of LHDs was determined for each jurisdiction change. Changes were analyzed by state, Profile cycle, and type of jurisdiction change. Principal Findings: LHD absorptions and mergers were common in several states (CO, CT, NJ, OH, WI) between 2005 and 2012, resulting in an overall decrease in the number of LHDs in those states and an increase in the average population served by an LHD in those states. Conclusion: Common drivers for LHD jurisdiction change include financial incentives from state health agencies and local desire to reduce costs of providing public health services. Additional research is needed to assess the extent to which jurisdiction changes resulted in changes in capacity to provide public health services. Implications for the Field of PHSSR: Consolidation of LHD jurisdictions is one way to increase the capacity for LHDs to provide essential public health services. Because most LHDs in the U.S. serve small populations, understanding where and how efforts to decrease the number of small LHD jurisdictions have been successful is important for policy-makers.
Room: Thoroughbred 1
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Concurrent Sessions
SESSION 3A: Technology & Data III-Wednesday, April 10, 2013, from 10:45 am to 12 pm
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Concurrent Sessions
SESSION 3A: Technology & Data III-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Analysis: TRAIN provided sufficient data on the public health workforce for the initial extraction of three datasets. While the data are limited to public health professionals using TRAIN and thereby factors heavily on health departments using TRAIN, TRAIN still provides the sole cross-jurisdictional source of data on the public health workforce. Principal Findings: The following tailored datasets were generated from the TRAIN database: demographics on TRAIN users; information on TRAIN courses and competencies; and number of TRAIN courses covering particular competencies; and the number of participants. Additional data are available on TRAIN by researcher request. Conclusion: TRAIN data can be used to respond to specific questions posed by the PHSSR field. The three TRAIN-tailored datasets provide information needed to help shape the National Research Agenda for PHSSR, while additional researcherrequested data can, in the future, help both craft and answer research questions in PHSSR. Implications for the Field of PHSSR: TRAIN provides valuable data for the continued study of the public health workforce. The three tailored TRAIN datasets provide insight on the public health workforce composition, the courses available and the competencies those courses train that workforce in, and the professional roles attaining those competencies.
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SESSION 3B: Workforce II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Room: Thoroughbred 2
The Future of Teaching in Local Health Departments: Implications for Academic Public Health and Workforce Development
Co-Investigators: Dorothy Cilenti, Dr.P.H., M.P.H., M.S.W.; Michelle Menegay, M.P.H., B.A. Research Objective: The purpose of this study is to investigate how much and what kind of teaching is occurring in local health departments (LHD); how that changes with decreases in LHD resources; and how LHD attitudes about academic public health are associated with teaching involvement. Data Sets and Sources: This data set represents an original survey of all LHDs in two geographically distinct states. Participants include 183 health directors and division directors from 90 of 125 LHDs in the state with data collection completed; and from 42 of 85 LHDs in the state where data are still being collected. Study Design: Survey development included qualitative interviews of key academic and LHD leadership. This cross-sectional survey research was conducted among participants in two Public Health Practice-Based Research Networks. Ninety-seven percent believe it is important for MPH students to have teaching experience in LHDs. Analysis: Descriptive analysis of LHDs and their teaching experience was conducted. A scale was developed to assess LHD attitudes about academic public health with a Cronbachs Alpha = 0.86. Associations between LHD characteristics and teaching experience were examined utilizing logistic regression. All analyses were conducted with SPSS v.20. Principal Findings: Substantial decreases in services were noted among 80% of LHDs. Still, LHDs were highly involved with teaching, and 65% of programs are relating to more than five academic institutions. Internships, practicums, and capstones were most valued, while shadowing was the most common teaching mechanism. Highly negative attitudes about academic public health were noted. Conclusion: LHDs are hurting. Diverse demands exist for teaching opportunities. Conflicting forces may reduce some opportunities and open others. Nursing, not Public Health, students are the most frequently instructed students in LHDs. Negative attitudes about academic public health imply need for substantial reconciliation with public health practice. Implications for the Field of PHSSR: Findings have significant implications for academic teaching programs, the future of the public health workforce, and research in public health LHDs. With practicum requirements for all MPH students, a 52% increase from 2000 to 2010 in students in MPH programs, and many new undergraduate public health programs, dialogue with LHDs is essential.
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Concurrent Sessions
SESSION 3B: Workforce II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Concurrent Sessions
SESSION 3B: Workforce II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Analysis: NACCHO Profile Survey data were mapped, identifying regions of the country with high rates of LHD FTE job loss. Bivariate analyses were conducted to determine if there were significant relationships between changes in a jurisdictions LHD per capita workforce and county-level poverty and race/ethnicity. Principal Findings: Substantial workforce data were missing from NACCHO Profile Surveys. A disproportionate reduction in percent change in FTEs among jurisdictions with high percent Black population, and an increase in percent change in FTEs among jurisdictions with high percent Hispanic population were identified. No statistically significant results were found regarding poverty. Conclusion: Continued consistent data collection on LHD workforce is warranted. Additional practice-based research is also needed to explore the disproportionate impact of LHD workforce cuts among jurisdictions with high percent Black population, and the growth of the LHD workforce among jurisdictions with high percent Hispanic population, contrary to overall decreases nationwide. Implications for the Field of PHSSR: Exploring the relationship between LHD workforce cuts and sociodemographic characteristics across geographic areas is of particular relevance to PHSSR regarding LHD workforce, social determinants of health, and health disparities. This research has the potential to inform critical decision-making and LHD resource allocation during times of economic hardship.
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Concurrent Sessions
SESSION 3C: Translation II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Room: Thoroughbred 3
Implementation of a Statewide Health System Reform Initiative: Lessons Learned on Factors That Facilitate and Impede Local Public Health Performance
Co-Investigators: Beth Gyllstrom, Ph.D., M.P.H. Research Objective: The Minnesota (MN) Public Health Practice-Based Research Network conducted a study of the statewide implementation of an evidence-based health system reform initiative to achieve policy, systems and environmental (PSE) changes. The main objective is to identify and examine local factors that facilitated or impeded the rapid, statewide roll-out of a novel initiative. Data Sets and Sources: Qualitative interviews were conducted with 15 key informants (100% response rate) targeted to represent the full range of Minnesotas geographic regions, LHD sizes and structures, and three levels of grantee performance, in order to help interpret and extend quantitative findings. Study Design: This qualitative study complements a quantitative study of factors related to successful implementation of PSE strategies addressing obesity, tobacco use and physical activity in communities. This abstract is closely linked to two other abstracts presenting the quantitative results, engagement of stakeholders and dissemination of study results. Analysis: Interviews were transcribed verbatim. Two investigators (who were also the study interviewers) independently reviewed transcripts for preliminary themes and used a coding system identified by Hahn. Study investigators then worked collaboratively to identify comprehensive themes from the data. Principal Findings: Swift implementation challenged all LHDs. Organizational factors that aligned with higher performance and sustainability include: willingness to try new approaches; capitalizing on a mix of new and established staff; and granting staff freedom to act, while also providing on-going leadership and connection to largely elected community health boards. Conclusion: Key informants repeatedly praised the regional approach of this initiative. Informants also cautioned against trying to create efficiencies by introducing too many new novel programs at once and identified implications of having to quickly ramp up their organizations to implement a statewide program of unprecedented scale and significant political scrutiny. Implications for the Field of PHSSR: Lessons learned from this statewide rollout of a community-driven, evidence-based initiative relate to several LHD characteristics, including organizational structure, leadership, staffing and sustainability. Findings have influenced the direction of new public health initiatives in Minnesota, and may be relevant to emerging initiatives elsewhere. Findings suggested questions for future research.
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Concurrent Sessions
SESSION 3C: Translation II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Concurrent Sessions
SESSION 3C: Translation II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Study Design: We conducted a cross-sectional study to examine self-reported activities and perceptions of public health researchers around dissemination of research findings. Survey items included target audience for dissemination (e.g., state and local health departments), respondent characteristics (e.g., work setting), facilitators (e.g., training in communication), and barriers (e.g., lack of incentives). Analysis: Distributions and univariate statistics were computed to describe the study population. Logistic regression was used to estimate odds ratios and 95% confidence intervals to examine the likelihood of dissemination to practitioners across predictor variables, with and without adjustment for respondent characteristics. Additional analyses were stratified by respondents research setting. Principal Findings: Survey respondents represented both academic (24% in PRC, 41% in non-PRC), and governmental (13% in CDC, 9% in NIH) settings. The frequency of active dissemination was 46% to local health departments, 49% to state health departments, 64% to federal agencies, and 32% to elected officials. Conclusion: The likelihood of active dissemination to public health practice settings was highest for federal agencies. Facilitators to active dissemination included expectations by funders and employers, as well as self-rated importance. Barriers included lack of relationships with stakeholders and uncertainty about what to disseminate. Implications for the Field of PHSSR: Active dissemination of research findings to practice settings is a core component of many PHSSR studies. These findings increase our understanding of factors related to public health researchers directly and actively disseminating findings, and may be used to support future work to enhance translation of relevant research to practice.
Concurrent Sessions
SESSION 3C: Translation II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Implications for the Field of PHSSR: The Minnesota PBRN has expanded beyond traditional dissemination techniques to pursue additional vehicles that are available to network partners and relevant to stakeholders. Lessons learned could be timely and useful to other PBRNs monitoring their own operations, and partnering to influence policy and practice in their respective states.
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SESSION 3D: Quality Improvement II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Research Objective: Tuberculosis (TB) prevention may be undervalued, hence underemphasized in policy and practice. Disproportionate mortality risk plausibly persists among some patients, despite cure. Evidence of post-cure mortality risk may promote prevention and offer opportunity for health protections; we analyzed mortality of TB survivors relative to a similar population seeking such evidence. Data Sets and Sources: We identified case and comparison cohorts using health authority records from the states of Texas and Massachusetts and the catchment of the Seattle/King County Public Health Department; strengthened identification and match probability using LexisNexis Accurint database; and ascertained vital status using CDCs National Death Index. Study Design: We selected 3,853 individuals who completed treatment for active TB and 7,282 individuals diagnosed with LTBI between 1993 and 2002, and recorded standardized available risk factor and individual characteristics for adjustment and control. We ascertained each subjects vital status as of 12/31/2008 via NDI, then compared mortality and its associations. Analysis: We analyzed mortality among two subject cohorts using Cox regression controlled for identified individual risk factors and characteristics. Observation duration began at treatment completion for TB survivors and at report to health authorities for LTBI subjects; it ended at death or survival to the end of 2008. Principal Findings: TB survivors experienced an average excess 7.6 deaths/1,000 person years (8.8 vs. 1.2 (p-value<.001)). White race, site of disease, HIV +, and U.S. nativity predicted mortality among these. More (20% vs. 3.1%) case subjects were dead at NDI match, averaging 4.1 years survival after cure. Conclusion: Tuberculosis prevention has value not reflected by current policy and practice. Analysis of fully treated TB survivors identified mortality 7.6 times greater than expected; 20% had died just four years after treatment. Tuberculosis cure offers insufficient protection against grave mortality risk, but opportunity exists to modify this risk. Implications for the Field of PHSSR: Evidence can guide health care systems toward more effective policy and practice. In TB control, evidence of excess mortality risk persisting after cure may promote prevention and facilitate elimination. Furthermore, understanding the distribution of risk by individual factors allows more efficient targeting of efforts and populations to maximize returns.
Concurrent Sessions
SESSION 3D: Quality Improvement II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Data Sets and Sources: Project leads from the Association of State and Territorial Health Officials (ASTHO) identified four states that have improved their rankings in selected measures. ASTHO conducted interviews with four to five key informants from each state. Interviewees included state, local, and community-level public health practitioners. Study Design: Following the Social Ecological Model, ASTHO has adapted a framework used in the education sector to understand how conditions affecting policy and systems change move from the state policy level to the community practice level. Analysis: Qualitative data from interviews with state, local and community level practitioners were analyzed to write a report for each state on the passage of a state health improvement policy and its implementation at the local and community levels. Principal Findings: Quality improvement played a significant role in the health improvement programs of two states. A quality improvement perspective was used to bring stakeholders from different sectors to the table, boost accountability, and streamline organizational processes within the state health agency. Conclusion: Quality improvement can be a useful lens to emphasize collaboration, accountability, and efficiencies for statewide health improvement programs. Implications for the Field of PHSSR: This research helps understand the mechanism for successful statewide health improvement programs, so that best practices can be disseminated across the states. ASTHO will facilitate sharing of lessons learned among public health leaders in order to improve health outcomes.
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Concurrent Sessions
SESSION 3D: Quality Improvement II-Wednesday, April 10, 2013, from 10:45 am to 12 pm
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Concurrent Sessions
SESSION 3E: Social Network Analysis-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Co-Investigators: Ryan Bell, M.P.H., Elisia Cohen, Ph.D., M.A., Ross C. Brownson, Ph.D. Research objective: Effective dissemination of evidence-based strategies among local health departments (LHDs) is a significant barrier to adoption of these strategies. New social media connections have the potential to facilitate dissemination of information about their experiences, lessons learned, and other resources related to evidence-based public health. The goal of this presentation is to assess the current network of social media connections among LHDs nationwide. Study design: Cross-sectional data on the network of Twitter connections among local health departments nationwide was collected through NodeXL in February, 2013. Descriptive and statistical network analysis were used to identify associations between local health department characteristics and social media connections. Population studied: The population included the 218 local health departments nationwide that had adopted Twitter as of July, 2012. Principal findings: Of the 218 LHDs, 186 LHDs (85%) were connected with at least one other LHD through Twitter, although most LHDs only had one or two connections total. LHDs with more constituents and LHDs employing a public information specialist were more likely to be followed by other health departments on Twitter. Per capita funding was negatively associated with being followed; LHDs with higher per capita funding levels were less likely to be followed by other LHDs. LHDs conducting the same programs, in the same state, and sharing a geographic border were more likely to be linked on social media. Conclusions: Most LHDs are connecting to other LHDs through social media. Larger LHDs were more likely to be followed by other LHDs. LHDs also appear to be connected to those that are geographically closest and that are conducting the same types of programs. Implications for Policy, Delivery, or Practice: While the network of connections on social media is relatively dense indicating the LHDs on Twitter are connecting to one another, those LHDs that are connected to most often tend to be large or nearby. Local health departments may benefit from seeking out connections with health departments that are not the usual suspects.
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Concurrent Sessions
SESSION 3E: Social Network Analysis-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Concurrent Sessions
SESSION 3E: Social Network Analysis-Wednesday, April 10, 2013, from 10:45 am to 12 pm
Analysis: Analysis to understand and explain the process of collaboration requires an understanding of the relationships among a number of factors (e.g. in a dynamic system with nested levels of interaction). Completed, ongoing, and potential analysis options of the PARTNER data will be presented/discussed. Principal Findings: Only by examining the whole network can we understand such issues as how networks evolve, how they are governed, and, ultimately, how collective outcomes might be generated (Provan et al. 2007). This dataset includes measures on characteristics of organizations as well as relational questions, representing whole networks in public health. Conclusion: While the benefits of collaboration have become widely accepted and the practice of collaboration is growing within the public health system, the ability to measure, document, and strategize to affect practice has been weak. This dataset presents an opportunity to answer important PHSSR questions in new ways. Implications for the Field of PHSSR: In the case of collaboration, it is important to recognize that both the resources (inputs) and activities carried out (processes) must be addressed together to improve public health services. The development and sharing of these data allow researchers and practitioners to gain more insight on collaboration to develop evidence-based practice.
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Concurrent Sessions
SESSION 4A: Accreditation-Wednesday, April 10, 2013, from 2 to 3:15 pm
SESSION 4-WEDNESDAY, APRIL 10, 2013 FROM 2 TO 3:15 pm SESSION 4A: Accreditation Room: Thoroughbred 1
Moderator: Paul Halverson, M.D. Dean, School of Public Health Indiana University-Purdue University Indianapolis Public Health PBRN National Advisory Committee Member Nikki Rider, Sc.D., M.P.P., B.S.
Evaluation of the National Public Health Improvement Initiative: Methods and Findings from the First Two Years
Co-Investigators: Mary Davis, Dr.P.H., M.S.P.H.; Anita McLees, M.A., M.P.H.; Saira Nawaz, Ph.D.; Brittany Bickford, M.P.H. Research Objective: The evaluation of the National Public Health Improvement Initiative (NPHII) is designed to increase understanding of the extent to which NPHII has supported: Increased readiness of its awardees for accreditation through the Public Health Accreditation Board (PHAB); Increased efficiency/effectiveness through quality improvement (QI); and Increased performance management capacity. Data Sets and Sources: Data sources include quantitative and qualitative data collected via the evaluation and program, such as: three rounds of the NPHII annual assessment; implementation stories; awardee interim and annual progress reports; and awardee work plans. Study Design: Evaluation activities are grounded in both utilization-focused and strategic evaluation theoretical models and build off previous efforts to measure performance management capacity. The formative evaluation design uses mixed methods data collection. Analysis: Quantitative analysis included descriptive statistics; qualitative data were coded and analyzed to extract relevant themes. When appropriate, comparisons across time and across various descriptive dimensions of awardees (e.g., awardee type, awardee funding level) were conducted. Principal Findings: As of November 2012, awardees reported progress toward accreditation readiness, including completion of PHAB prerequisites (74%). Eighty-nine percent of awardees have established at least one component of a performance management system. Awardees also report improvements in their culture and environment to support QI and performance management activities. Conclusion: NPHII awardees have made progress and have measurable successes in the areas of accreditation readiness, QI, and performance management. Evaluation results have helped increase understanding of the challenges experienced by awardees and have informed programmatic improvements to address these challenges when possible.
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Concurrent Sessions
SESSION 4A: Accreditation-Wednesday, April 10, 2013, from 2 to 3:15 pm
Implications for the Field of PHSSR: NPHII is designed to strengthen the nations public health system by optimizing resource utilization and increasing awardees performance management capacity and ability to meet national standards. Through NPHII, we are learning how accreditation readiness, performance management systems, and QI strategies impact the effectiveness, efficiency, and outcomes of public health strategies.
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Concurrent Sessions
SESSION 4A: Accreditation-Wednesday, April 10, 2013, from 2 to 3:15 pm
Concurrent Sessions
SESSION 4A: Accreditation-Wednesday, April 10, 2013, from 2 to 3:15 pm
Analysis: We performed parametric and non-parametric bivariate analysis for predictors, including governance/funding, leadership/workforce, accreditation prerequisites, barriers to accreditation, and community characteristics. For the multivariate analysis of accreditation status, we performed binary logistic regression. Principal Findings: Preliminary analyses show associations between accreditation status and multiple organizational, structural, workforce, and community level predictors, including funding, governance by a local board of health, administrator with at least a masters degree, completion of accreditation prerequisites, utilization of performance management and improvement principles and tools, and multi-jurisdictional partnerships. Conclusion: Accredited LHDs differed on many organizational, structural, workforce, and community level factors; many of these are amenable in nature. Interestingly, LHDs located near accredited LHDs are more likely to also be accredited. Implications for the Field of PHSSR: Understanding the characteristics of non-accredited LHDs that differ from accredited LHDs in terms of leadership, structure, budget, and workforce has important implications for LHDs, local and national voluntary accreditation programs and their partners.
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Concurrent Sessions
SESSION 4B: Workforce III-Wednesday, April 10, 2013, from 2 to 3:15 pm
Room: Thoroughbred 2
Moderator: Kathleen Amos, M.L.I.S. Project Manager, Council on Linkages Between Academia and Public Health Practice Beth Resnick, M.P.H.
Discerning Workforce Composition With Incomplete Estimates
Co-Investigators: J.P. Leider, Ph.D. (presenting); Beth Resnick M.P.H.; Patrick Bernet, Ph.D.; Jessica Young, M.S. Research Objective: In the absence of administrative data, self-reported estimates from major public health organizations such as ASTHO and NACCHO are the best means of enumerating the workforce at state and local health departments. However, incomplete data complicate estimation of workforce composition, e.g., part-time/full-time staffing split. Data Sets and Sources: Workforce estimates from ASTHO and NACCHO 2007/2008 and 2010 Profiles. Study Design: Using staffing and FTE estimates, we examined likely FTE allocation scenarios that yield estimates of workforce composition by part-time/full-time staff effort, including how many FTEs are allocated to part-time staff versus full-time, as well as staffing estimates. Analysis: We will report descriptive statistics on estimated part-time vs. full-time allocation split in 2008 vs. 2010, and report correlates of decreasing utilization of part-time positions. Principal Findings: Under a scenario where the average part-time allocation is 0.5 FTEs per staff, data from ASTHO suggest the part-time workforce decreased from 12% in 2007/2008 to 7% of the workforce in 2010. Data from NACCHO suggest a reduction from about 23% of the workforce to 21% during 2008-2010. Conclusion: Though not entirely consistent across all jurisdictions, it appears that a shift occurred between 2008 and 2010 in health departments that saw a moderate decline in part-time staffing in favor of full-time staff. Implications for the Field of PHSSR: Although the beginning of a trend toward an even more full-time workforce may be underway, understanding the motivations and drivers of this trend is critical. The impact of civil service and union requirements should be measured, as well as the impact of state law on workforce decision-making.
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Concurrent Sessions
SESSION 4B: Workforce III-Wednesday, April 10, 2013, from 2 to 3:15 pm
76
Concurrent Sessions
SESSION 4B: Workforce III-Wednesday, April 10, 2013, from 2 to 3:15 pm
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Concurrent Sessions
SESSION 4C: Food Safety-Wednesday, April 10, 2013, from 2 to 3:15 pm
Room: Thoroughbred 3
Moderator: Glen Mays, Ph.D., M.P.H. Director, Public Health PBRN National Coordinating Center Co-Investigator, National Coordinating Center for PHSSR Justeen Hyde, Ph.D.
Retail Food Safety Programs: What Factors Are Associated With Best Practices in Massachusetts?
Co-Investigators: Lisa Arsenault, Ph.D.; Nazmim Bhuiya, M.P.H.; Kathleen MacVarish, M.S.; Harold Cox, M.S.W. Research Objective: Retail food inspections are a core function in many local health departments across the nation. There is limited evidence regarding best practices for these services or outcomes they produce. This paper describes a screening tool created to measure food safety standards and factors associated with meeting these standards in Massachusetts. Data Sets and Sources: The Massachusetts Public Health Practice-Based Research Network conducted a structured survey with 249/351 (70%) local boards of health in the state. The survey examined local context, public health infrastructure, capacity to provide essential public health services, and capacity to meet food safety and communicable disease standards. Study Design: This paper reports on findings from an analysis of retail food safety practices among local boards of health. The measure used in the survey was created from the FDAs Voluntary Retail Food Safety Program Standards. We used these standards to create a 25-item screening instrument that included eight domains. Analysis: Total capacity score was divided into quartiles based on the distribution of the analytic sample. Indicators were compared across the four quartiles to determine statistically significantly indicators using two tests and Spearman correlation coefficients. A logistic regression model was then constructed to predict performance scores in the highest quartile. Principal Findings: The strongest predictor of capacity in a multivariate analysis was performance of essential public health services (lowest vs. highest quartile, p=.0008) and elected officials understanding of board of health responsibilities (p=.06). Capacity to assess inspectional services and provide community education differentiated high vs. low capacity in the state. Conclusion: In this study, we found that capacity to perform essential public health services was strongly associated with quality inspectional food safety services in local health departments. Our findings support other PHSSR studies that highlight the importance of improving the capacity of local health departments to perform essential public health services. Implications for the Field of PHSSR: This study adds to the limited evidence on retail food inspection services. The screening tool is among the first of its kind and may be adapted for future PHSSR studies. The results also highlight an important association between performance of essential public health services and high quality food safety practices.
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Concurrent Sessions
SESSION 4C: Food Safety-Wednesday, April 10, 2013, from 2 to 3:15 pm
demographics, workforce size, and per capita spending. FSE characteristics include area-level poverty, and size and type of establishment. Data Sets and Sources: Original data are collected utilizing an innovative direct observation methodology adapted from primary care Practice-Based Research Networks (PBRN), utilizing trained student observers and a validated observational protocol. Pre- and post-inspection interviews with sanitarians further inform process. Data integration is achieved using annual financial reports, public health performance standards, and U.S. Census data. Study Design: This PBRN project is a comparative case study design utilizing mixed methods, including direct observation, interview, and data integration from existing databases. Participants: A convenience sample of approximately 30 Ohio LHDs and 50 geographically and demographically diverse Ohio Registered Sanitarians (RS) with more than 600 observed inspections. Analysis: Multivariable data integration among original data utilizing qualitative field notes, quantitative direct observation, and interviews; with statewide public health performance standards and LHD Annual Financial reports with variables including workforce size and composition, public health spending, and funding sources. Finally, analysis will integrate Census tract-level demographic data. Principal Findings: Preliminary analysis reveals citations issued in 67% of inspections (2.19/FSE inspection) and verbal corrections given in 80% of inspections (1.93/inspection). In most instances (54%), violations were dealt with during the inspection. Sanitarians offered clear feedback and assessment (98.5%), discussed improvement plan (87%), offered food safety education (69%), and elicited questions (77.5%). Conclusion: Sanitarians discovered frequent food safety violations, while offering consistent information to prevent future foodborne outbreaks. Data integration to establish patterns related to these outcomes will be completed and presented. FSE Employees were cooperative (97.5%) and engaged (88%) and thanked the Sanitarian 91% of the time. Implications for the Field of PHSSR: This study utilizes original data collection and existing data sources to identify patterns of variation on LHD performance, introducing a direct observation methodology intended to reduce research error variation. This method holds potential to significantly enhance the knowledge base of public health practice, as it has done in primary care.
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Concurrent Sessions
SESSION 4C: Food Safety-Wednesday, April 10, 2013, from 2 to 3:15 pm
Principal Findings: State health departments operating under different governance classifications reported significantly different totals of hospitalization to the CDC (p=0.033). Specifically, centralized and mixed states had significantly different reports to the CDC (p=0.048), as well as mixed and decentralized (p=0.021), after standardizing for population. Conclusion: Findings from this study suggest that organization and governance are associated with FBDO reporting fidelity. Implications for the Field of PHSSR: Further investigation into governance, as well as other state health department characteristics as they relate to FBDO reporting, will provide insight on how to best utilize limited department resources and improve health outcomes, as well as provide the basis for an accurate system for reporting to federal agencies.
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Concurrent Sessions
SESSION 4D: Reducing Health Disparities-Wednesday, April 10, 2013, from 2 to 3:15 pm
Moderator: Francisco Sy, M.D., Dr.P.H. Director Extramural Activities and Scientific Programs National Center on Minority Health and Health Dispanties Melanie Peterson-Hickey, Ph.D., M.S., B.A.
Addressing Health Inequities The Role of Local Health Departments in Minnesota
Co-Investigators: Kim Edelman, M.P.H., B.A. (presenting) Research Objective: Increase understanding of readiness, capacity, and current efforts of Minnesota local health departments (LHDs) to address health disparities through a health inequities lens, focusing on upstream approaches including public policy and systems efforts. Data Sets and Sources: Utilized data from key informant interviews, online survey results from the Minnesota LHD Health Inequity Survey, a literature review of health inequity (HI) activities and concepts, and a review of existing documents including LHD Planning and Performance System, LHD Assessments, program evaluations, reports and local surveys. Study Design: Study methods include use of data from key informant interviews, literature, and existing documents to develop measures to assess health inequity efforts of LHDs. The survey was developed and administered online to LHD directors. Several of our partners assisted in the survey development and follow-up on the return of surveys. Analysis: Vovici software was used to gather online survey results. Results were analyzed in SPSS. Qualitative data were coded and analyzed for common themes and patterns. Project partners assisted in the review and analysis of results. Final results describe HI activities by structure and governance. Principal Findings: The survey response was 73%. Health inequities work varied widely. Some HI efforts were targeted, while others were incorporated into ongoing activities. The majority of HI activities were focused on individuals and less on upstream prevention. Conclusion: There is a need to develop greater understanding of multiple contributing factors to illness and disease. Technical assistance is needed on the impact of HI on public health, program development and data assessment. Support for successful implementation of HI activities at the local level is needed. Implications for the Field of PHSSR: This project will contribute to the PHSSR field by adding knowledge of current HI efforts at LHDs, and how these efforts are shaped by organizational characteristics related to structure, funding and staffing.
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Concurrent Sessions
SESSION 4D: Reducing Health Disparities-Wednesday, April 10, 2013, from 2 to 3:15 pm
Concurrent Sessions
SESSION 4D: Reducing Health Disparities-Wednesday, April 10, 2013, from 2 to 3:15 pm
Principal Findings: Several important themes emerged to facilitate or inhibit the adoption of health equity activities. Some of these themes included: language choice, constraints of funding streams, data capacity, reorganization, and other workforce development. Additional findings and some best practices will be presented. Conclusion: This project will support, build, and formalize the California Public Health Practice-Based Research Network. Anticipated findings may result in an intervention to improve resources and skills to improve workforce capacity in addressing health equity. Cross-jurisdictional sharing may offer one potential solution to support health equity activities. Implications for the Field of PHSSR: This preliminary study and its findings provide support for rethinking models for crossjurisdictional sharing. It highlights opportunities for workforce development to better engage with health equity. This workforce development may have additional implications for health department performance.
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Concurrent Sessions
SESSION 4E: Technology & Data IV-Wednesday, April 10, 2013, from 2 to 3:15 pm
A Framework to Measure and Improve the Content, Quality, and Timeliness of Electronic Health Data
Co-Investigators: Shaun Grannis, M.D., M.S., B.S., FAAFP Research Objective: To develop a framework for characterizing and improving the content, quality, and timeliness of electronic health data, which is increasingly leveraged by public health systems and services to assess and monitor the health of populations. Data Sets and Sources: A review of the existing literature in business, information technology, and government was used to develop a novel framework for examining the quality of electronic health data. Study Design: Health care organizations are increasingly using health information technologies to collect, store, manage, and analyze data. Given increasing availability of electronic health data, many health departments are developing strategies to leverage electronic data for biosurveillance, notifiable disease reporting, chronic disease monitoring, and identification of health disparities. Analysis: An unsupported assumption is that electronic health care data are of sufficient quality to enable the varied uses envisioned by health departments. The reality is that many electronic health data sources are of suboptimal quality and likely unfit for particular uses. Principal Findings: To systematically characterize and improve the content, quality, and timeliness of electronic health data, we propose a novel framework for electronic health data quality. The framework is adapted from prior data quality research but has been reshaped to apply a systems approach to data quality with emphasis on population outcomes. Conclusion: The proposed framework is a beginning, not an end. We invite the public health services and systems research community to use and adapt the framework to improve electronic health data quality and outcomes for populations across the nation as well as globally. Implications for the Field of PHSSR: This work moves PHSS researchers and practitioners toward a consensus-based model for characterizing and improving the content, quality, and timeliness of the data used by surveillance systems and other core functions of public health. This is a key research question in the national PHSSR agenda.
Concurrent Sessions
SESSION 4E: Technology & Data IV-Wednesday, April 10, 2013, from 2 to 3:15 pm
Study Design: Respondents answered 57 Likert scale items that measured their perceptions of the relative importance of indicators of a successful CHA-CHIP. Participants also used the ARS to explore ways to (1) implement the project; (2) design project surveys; (3) identify focus group participants; (4) recruit participants; and (5) efficiently collect data. Analysis: Items were rank ordered using mean scores by group (public health, hospital, total, previous CHA-CHIP experience). Qualitative analysis was done on information pertaining to the organization of project activities. Principal Findings: Items rated as important by all participants included: CHA-CHIP developed with stakeholder partners; CHACHIP has measurable objectives; and timeframes and the process includes elected officials. Participants expressed enthusiasm and appreciation for being involved in study-design activities and provided critical input for the organization of project activities. Conclusion: The use of ARS facilitated the engagement of practitioners interest, sustaining their motivation and attention during the kick-off meeting and fostering their ownership for the project. At the same time, this strategy allowed the identification of areas important to public health practitioners engaged in CHA-CHIP activities. Implications for the Field of PHSSR: Involvement in PHSSR of public health practitioners is difficult, particularly in rural states. The use of ARS for PHSSR is a relatively low-effort tool that can promote action-oriented participatory research in public health.
Concurrent Sessions
SESSION 4E: Technology & Data IV-Wednesday, April 10, 2013, from 2 to 3:15 pm
86
Posters
Poster Session A-Tuesday, April 9, 2013 from 5:30 to 6:30 pm
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Posters
Poster Session A-Tuesday, April 9, 2013 from 5:30 to 6:30 pm
Board 9: Succession Planning in Health Departments: The Road Not Taken Julie Darnell, Ph.D. Co-Investigators: Joshua Franzel, Ph.D.; Susan Cahn, M.A. Board 10: Findings from the 2011 National Association of Local Boards of Health Profiles Jeff Jones, Ph.D., M.A., B.A. Co-Investigators: Ginger Fenton, Ph.D.; Stephanie Branco, M.S. Board 11: Examining Infant and Neonatal Mortality by Community Health Center Concentration Priscilla Barnes, Ph.D., M.P.H., CHES Co-Investigators: Melody Goodman, Ph.D., M.S.; Arlesia Mathis, Ph.D.; Gulzar Shah, Ph.D., M.S.; Masayoshi Oka, DDes, MES Board 12: Local Health Departments Delivery of MCAH Services/Programs and Performance of Essential Services for MCAH Population L. Michele Issel, Ph.D., RN Co-Investigators: Hale Thompson, M.P.H.; Arden Handler, Ph.D. Board 13: Evaluating Patient Centered Medical Home and Panel Management Practice Implementation in Primary Care Safety-Net Clinics Nicole Cook, Ph.D., M.P.A., B.A. Co-Investigators: T. Lucas Hollar, Ph.D., B.A. Board 14: Is Telephone-Based Partner Notification for STIs Cost-Effective? M. Mahmud Khan, Ph.D. Co-Investigators: Mohammad Rahman, Ph.D.; Lizheng Shi, Ph.D. Board 15: Validity and Reliability of the Direct Observation Methodology: A Focus on Ohio Local Public Health Michelle Menegay, M.P.H., B.A. Co-Investigators: Scott Frank, M.D., M.S.
88
Posters
Poster Session B-Wednesday, April 10, 2013 from 5:30 to 6:30 pm
89
Posters
Poster Session B-Wednesday, April 10, 2013 from 5:30 to 6:30 pm
Board 10: Academic-Health Department Collaborations Support Public Healths Core Competencies and Essential Functions Elizabeth Neri, M.P .H. Co-Investigators: Marie Ballman, M.P.H; Hua Lu, M.S. Board 11: Environmental Policy Through the Lens of Public Health: A Public Health-Environment Agency Partnership in the United Arab Emirates Jacqueline MacDonald Gibson, Ph.D., M.S., B.A. Board 12: The Dynamics of Maternal and Child Health Partnerships: The Scope of Public Health Systems to Address Unmet Maternal and Infant Health in a Community Setting Sharla Smith, M.P .H., B.S. Board 13: Partner Services in New York State: Provider Awareness of the Integrated HIV/STD Field Services Program Britney Johnson, M.P .H. Co-Investigators: James Tesoriero, Ph.D.; Mara San Antonio-Gaddy, M.S.N. Board 14: Marginalization of School Health in the Public Health Workforce: Assessment of the Relationship Between Ohios Local Public Health Departments (LHD) and Schools Within Their Geographic Service Area Kristina Knight, M.P .H., B.S. Co-Investigators: Scott Frank, M.D., M.S.
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121 Washington Avenue Suite 212 Lexington, Kentucky 40536 Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org
121 Washington Avenue Suite 212 Lexington, Kentucky 40536 Tel. 859. 257. 5678 Fax 859. 257. 3748 www.publichealthsystems.org